Stefan Timmermans Amy Zhou University of California Los Angeles
The project contributes to research on global policy diffusion by examining how and when developing countries challenge global policy prescriptions. In addition, by operating at both the state and local levels, the project shows how national policies are improvised and re-interpreted in their implementation. This dissertation project traces the uneven diffusion of global health priorities to national policy and implementation. International organizations and states exert influence in shaping the policy decisions of developing countries. Yet developing countries vary in their responses to global policy prescriptions. Under what conditions do developing states diverge from policy prescriptions? How are new policies implemented and improvised upon in resource-constrained settings? This project focuses on a unique case of policy divergence from Malawi, one of the poorest countries in sub-Saharan Africa. In 2011, Malawi went against WHO guidelines and became the first country to adopt an HIV policy called ?Option B+?. The policy significantly expanded access to HIV treatment by providing pregnant and breastfeeding women immediate and lifelong access to treatment upon testing positive. This project examines why Malawi diverged from WHO guidelines to adopt Option B+, and how Malawian healthcare providers and patients understand and act upon this new policy.
Data for the project comes from ethnographic observations and interviews with actors at both the state and local level. At the state level, interviews with members of state agencies and international organizations involved in the Option B+ discussion specifies the unique roles that state and non-state actors have in developing policy. At the local level, interviews and observations at health care centers highlights if and when providers and patients deviate from treatment procedures and the logic that underpins their decisions.
Since Malawi's adoption of Option B+, the WHO revised their recommendation in 2012 to include Option B+ as an advantageous third option and several countries in the region are considering the policy change. Because the policy is new and untested, there are key concerns regarding barriers to care, adherence to treatment, and possible tensions between partners and community members. This project can create interdisciplinary dialogue. Sociological insights and the richness of qualitative data can inform public health professionals on the unintended consequences of the policy and possible ways to increase uptake and adherence to HIV medication.